Tag Archives: Training

Patient and Public Involvement: Direct Involvement of Patient Representatives in Data Collection

It is widely accepted that the public and patient voice should be heard loud and clear in the selection of studies, in the design of those studies, and in the interpretation and dissemination of the findings. But what about involvement of patient and the public in the collection of data? Before science became professionalised, all scientists could have been considered members of the public. Robert Hooke, for example, could have called himself architect, philosopher, physicist, chemist, or just Hooke. Today, the public are involved in data collection in many scientific enterprises. For example, householders frequently contribute data on bird populations, and Prof Brian Cox involved the public in the detection of new planets in his highly acclaimed television series. In medicine, patients have been involved in collecting data; for example patients with primary biliary cirrhosis were the data collectors in a randomised trial.[1] However, the topic of public and patient involvement in data collection is deceptively complex. This is because there are numerous procedural safeguards governing access to users of the health service and that restrict disbursement of the funds that are used to pay for research.

Let us consider first the issue of access to patients. It is not permissible to collect research data without undergoing certain procedural checks; in the UK it is necessary to be ratified by the Disclosure and Barring Service (DBS) and to have necessary permissions from the institutional authorities. You simply cannot walk onto a hospital ward and start handing out questionnaires or collecting blood samples.

Then there is the question of training. Before collecting data from patients it is necessary to be trained in how to do so, covering both salient ethical and scientific principles. Such training is not without its costs, which takes us to the next issue.

Researchers are paid for their work and, irrespective of whether the funds are publically or privately provided, access to payment is governed by fiduciary and equality/diversity legislation and guidelines. Access to scarce resources is usually governed by some sort of competitive selection process.

None of the above should be taken as an argument against patients and the public taking part in data collection. It does, however, mean that this needs to be a carefully managed process. Of course things are very much simpler if access to patients is not required. For example, conducting a literature survey would require only that the person doing it was technically competent and in many cases members of the public would already have all, or some, of the necessary skills. I would be very happy to collaborate with a retired professor of physics (if anyone wants to volunteer!). But that is not the point. The point is that procedural safeguards must be applied, and this entails management structures that can manage the process.

Research may be carried out by accessing members of the public who are not patients, or at least who are not accessed through the health services. As far as I know there are no particular restrictions on doing so, and I guess that such contact is governed by the common law covering issues such as privacy, battery, assault, and so on. The situation becomes different, however, if access is achieved through a health service organisation, or conducted on behalf of an institution, such as a university. Then presumably any member of the public wishing to collect data from other members of the public would fall under the governance arrangements of the relevant institution. The institution would have to ensure not only that the study was ethical, but that the data-collectors had the necessary skills and that funds were disbursed in accordance with the law. Institutions already deploy ‘freelance’ researchers, so I presume that the necessary procedural arrangements are already in place.

This analysis was stimulated by a discussion in the PPI committee of CLAHRC West Midlands, and represents merely my personal reflections based on first principles. It does not represent my final, settled position, let alone that of the CLAHRC WM, or any other institution. Rather it is an invitation for further comment and analysis.

— Richard Lilford, CLAHRC WM Director

Reference:

  1. Browning J, Combes B, Mayo MJ. Long-term efficacy of sertraline as a treatment for cholestatic pruritus in patients with primary biliary cirrhosis. Am J Gastroenterol. 2003; 98: 2736-41.
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Do we Need ‘Situations’ to Make a Situational Judgement Test?

Rank the following options in order of their likely effectiveness or the extent to which they reflect ideal behaviour in a work situation.

  1. Make a list of the patients under your care on the acute assessment unit, detailing their outstanding issues, leaving this on the doctor’s office notice board when your shift ends and then leave at the end of your shift.
  2. Quickly go around each of the patients on the acute assessment unit, leaving an entry in the notes highlighting the major outstanding issues relating to each patient and then leave at the end of your shift.
  3. Make a list of patients and outstanding investigations to give to your colleague as soon as she arrives.
  4. Ask your registrar if you can leave a list of your patients and their outstanding issues with him to give to your colleague when she arrives and then leave at the end of your shift.
  5. Leave a message for your partner explaining that you will be 30 minutes late.

053 GB - SJT Doctor

How would your ranking change if you knew the following about the situation?

You are just finishing a busy shift on the Acute Assessment Unit (AAU). Your FY1 colleague who is due to replace you for the evening shift leaves a message with the nurse in charge that she will be 15 to 30 minutes late. There is only a 30 minute overlap between your timetables to handover to your colleague. You need to leave on time as you have a social engagement to attend with your partner.

(Example from UKFPO SJT Practice Paper © MSC Assessment 2014, reproduced with permission.)

The use of situational judgement tests (SJTs) for selection into education, training and employment has proliferated in recent years, but there remains an absence of theory to explain why they may be predictive of subsequent performance.[1] The name suggests that the tests are an assessment of a candidate’s ability to make a judgement about the most appropriate action in challenging work-related situations; suggesting that the tests must include descriptions of such challenging work-related situations. But your ranking of the possible actions listed above probably did not change much (if at all) once you knew the exact details of the situation compared to when these had to be deduced from the possible actions listed. A similar finding was recently reported in a fascinating experiment conducted by Krumm and colleagues,[2] with volunteers randomised to complete a teamwork SJT with or without situation descriptions. Those given the situation descriptions scored, on average, just 8.5% higher than those not given the descriptions. Of course, consideration of the need for a situation description is only possible for SJTs in a format where possible actions are presented to candidates (commonly known as multiple choice), but this format is generally used in practice as it facilitates marking and scoring.

Krumm et al.’s findings clearly raise doubts as to the intended construct of the test (i.e. the candidate’s judgement of specific situations); yet SJTs are predictive of workplace performance, with correlations of around 0.30 reported in meta-analyses (see for example McDaniel et al.).[3] So if a SJT doesn’t actually require a “situation” to enable a useful assessment of a candidate’s likely future performance, then what exactly is the assessment of? Lievens and Motowildo [4] suggest that it is of general domain knowledge regarding the utility of expressing certain traits, such as agreeableness, based on the knowledge that such traits help to ensure effective workplace importance. The implication of this theory for practice is that SJTs may not need to be particularly specific and could therefore be shared across professions and geographical boundaries, making them a particularly cost-effective selection tool. The implication for research is that we need more evidence on the antecedents of general domain knowledge, such as family background, both as part of theoretical development and to evaluate the fairness of SJTs for selection.

And what if one does actually desire an assessment of situational judgement as opposed to general domain knowledge, since both have independent predictive validity for job performance? Rockstuhl and colleagues suggest that candidates need to be asked for an explicit, open-ended judgement of the situation (e.g. “what are the thoughts, feelings and ideas of the people in the situation?”) rather than what they think is the most appropriate response to it.[5] The nub here is whether including open-ended assessments to enable measurement of situational judgement is cost-effective given their incremental validity over general domain knowledge and the cost of marking responses (with at least two markers required). For the moment we simply note that a rather large envelope would be required for even a rapid assessment of selection utility!

— Celia Taylor, Senior Lecturer

References:

  1. Campion MC, Ployhart RE, MacKenzie Jr WI. The state of research on situational judgment tests: a content analysis and directions for future research. Hum Perform. 2014; 27(4): 283-310.
  2. Krumm S, Lievens F, Hüffmeier J, et al. How “situational” is judgment in situational judgment tests? J Appl Psychol. 2015; 100(2): 399-416.
  3. McDaniel MA, Hartman NS, Whetzel DL, Grubb III WL. Situational judgment tests, response instructions, and validity: a meta‐analysis. Pers Psychol. 2007; 60(1): 63-91.
  4. Lievens F, & Motowidlo SJ. Situational judgment tests: From measures of situational judgment to measures of general domain knowledge. Ind Organ Psychol. 2016: 9(1): 3-22.
  5. Rockstuhl T, Ang S, Ng KY, Lievens F, Van Dyne L. Putting judging situations into situational judgment tests: Evidence from intercultural multimedia SJTs. J Appl Psychol. 2015; 100(2): 464-80.

A Low-Value Paper on the Assessment of High-Value Care

The provision of ‘high-value’ care (HVC) – balancing health outcomes from treatment against financial costs, potential adverse events and the disutility of undergoing treatment – has become increasingly important in a time of austerity and patient-centred care. A recent paper in the Annals of Internal Medicine therefore set out to establish whether a subset of single-best answer questions used as part of a wider knowledge-based examination could be an effective tool for assessing trainees’ knowledge of HVC.[1] Thirty-eight existing questions were identified as assessing domains of HVC and the scores of around 18,000 residents were analysed for evidence of validity. We are not informed of the extent to which any of the measures of HVC used in the study were reliable, although an examination including just 38 questions is unlikely to have sufficient reliability to be used to classify trainees.

The analysis proceeds at the level of the training programme (N=362) and no data on the variability of trainees’ scores within a programme, compared to that between programmes, are provided. We are informed that the HVC subscore correlates positively at programme level with total examination scores, although no quantitative measure of the correlation is provided and any such measure would inevitably be biased upwards by the inclusion of the HVC subscore in the total score. Despite the authors’ statement that their findings “support the importance of the training environment in fostering HVC” (p. 737), there was poor agreement between programme quartiles based on HVC subscores and a measure of hospital care intensity (a quadratic weighted kappa of 0.17 was calculated from data provided). Evidence of validity at trainee level could have been provided, as survey data on self-reported HVC behaviours was also collected, but again analysed at programme level (with no consistent relationship identified across the eight HCV behaviours included in the survey).

Research in medical education – of which assessment is a key domain – is often seen as the poor bedfellow of clinical research. Guidance on reporting and interpreting validity evidence is available [2] and needs to be followed if medical education research is to raise its profile.

— Celia Taylor, Senior Lecturer

References:

  1. Ryskina KL, Korenstein D, Weissman A, Masters P, Alguire P, Smith CD. Development of a High-Value Care Subscore on the Internal Medicine In-Training Examination Assessing Residents’ Knowledge of HVC. Ann Intern Med. 2014; 161(10): 733-9.
  2. Downing SM. Validity: on the meaningful interpretation of assessment data. Med Educ. 2003; 37(9): 830-7